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MC-16-973`SNORes Miami Shores Village 10050 N.E. 2nd Avenue NW Miami Shores, FL 33138-0000 Phone: (305)795-2204 fGORIDp' Permit NO. MC-4-16-973 Permit Type: Mechanical - Residential Pen • Work Classification: A/C Replacement Permit Status: APPROVED issue Date: 5/612016 1 Expiration: 11/02/2016 Project Address Parcel Number Applicant 104 NW 102 Street 1131010220130 ALFREDO R PATINO Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell ALFREDO R PATINO 104 NW 102 Street MIAMI SHORES FL 33138- 104 NW 102 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone KARIBE MECHANICAL SERVICE LLC (305)235-4000 Tons: 4 Additional Info: EXACT UNIT CHANGE OUT. Classification: Residential Approved: In Review Comments: Date Denied: Scanning: 1 Fees Due Amount CCF $2.40 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.80 Notary Fee $5.00 Permit Fee $122.50 Scanning Fee $3.00 Technology Fee $3.20 Total: $140.90 Date Approved:: In Review Type of Work: Valuation: $ 3,500.00 Total Sq Feet: 0 Pav Date Pay Type Amt Paid Amt Due I Invoice # MC-4-16-59375 04/11/2016 Credit Card 05/06/2016 Credit Card $ 50.00 $ 90.90 $ 90.90 $ 0.00 Available Inspections: Inspection Type: Final Review Mechanical In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated. May 06, 2016 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy May 06, 2016 1 ill BUILDING PERMIT APPLICATION ❑ BUILDING ❑ ELECTRIC Miami Shores Village APR 112016 Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 (*--AS Master Permit No. Sub Permit No. 1 " `L! = ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ;K MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP '1 CONTRACTOR DRAWINGS JOB ADDRESS: / 07 �w ��� City: Miami Shores County: Miami Dade Zip: 33115-0 Folio/Parcel#: I i — 3A © t — 22 — 0 3o Is the Building Historically Designated: Yes NO Occupancy Type: R Load: Construction Type:%L0d4 Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): /� C ,�q� + Phone#: -3Old - 5G- n 0 Address: t OLk u w 102 ST City: Wd � . hC>«f`Q S State: Zip: "33 I 5;0 Tenant/Lessee Name: Phone#: Email: 5 H "Af Oo%KP, G% Nlpk - Cam^ CONTRACTOR: Company Name: k 4714C' /"/CY�ed�t/! / 1& i c P Phone#: 0 002) Address 1 '1,2�_5 /0,6 v I _1'9A'v A�—az - City: Quali State Certification or Registration #: CZ4 C `f 6 6—'> Certificate of Competency M DESIGNER: Architect/Engineer: Address: Value of Work for this Permit: $ Type of Work: ❑ Addition Description of Work: City: Square/Linear Footage of Work: Alteration ❑ New ❑ Repair/Replace te: Zip: ❑ Demolition Specify color of color thru tile: (') Submittal Fee $ (:;o " th) Permit Fee $ 1 v CCF $ 2 CO/CC $ Scanning Fee $_8 ,OQ Radon Fee $ 2 ' co DBPR $ _ 2 ` Oo Notary $ Technology Fee $ 3 2 U Training/Education Fee $ " 80 Structural Reviews $ O _ (Revised02/24/2014) Double Fee $ Bond $ SD TOTAL FEE NOW DUE $ 0 O 9DC7 ;Ue RON Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The fore oing instrument was acknowledged before me this ti day of 4 20 by --I day of J'y�Q,u 20 lj�P by at_1�0 �ZaFa4ELPMNawho is personally known to (r As?lOSEIC&j>!IsJ E- L, who is personally known to me or who has prod ucedTL— t>eA \E - L%c9E(`1S'li's me or who has produced J�j,., . identification and who did take an oath. identification and who did take an oath. NOTARY LIC: NOTARY PUBLIC: Sign: Sign: Prin . �) �Wl� Print: Seal: 0 P`e�A Notary P+iblir, State of Florida Seal: "•,, DIANE L. KESSELL •*-, =o Sindia Alvarez • =Commission # FF 232916 ?pFpdF� My Commission FF 156750 Expires 03I0312018 �� p p s�i��. Expires September 10, 2019 0 SwOod Thru Troy Fan Invzom 90D M5.701i APPROVED BY Plans Examiner Structural Review Zoning Clerk (Revised02/24/2014) Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax:(305) 756.8972 AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC This form must accompany ALL air conditioning replacement permit applications. Each unit change -out must be on its own data sheet. Multiple units on single sheets are not acceptable. Job Address (where the work is being done): % © y 'U u.i % 0 jq S7f City: Miami Shores Village County: Miami Dade Zip Code: ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS AHRI DATA SHEET REQUIRED Change disconnecting means: YES NO ❑ ARHI Sheet Attached: YES X NO ❑ Contract Attached: YES ❑ UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER PP/ AHU or PKG. UNIT MODEL # COND. UNIT MODEL # KW HEAT - NOM TONS 41 AHU CU PKG 1) M.C.A AHU CU PKG AHU Cu PKG 2) M.O.P AHU CU PKG AHU CU PKG 3) VOLTS AHU CU PKG PKG UNIT / / PKG UNIT EER/SEER in YES NO REPLACING DUCTS YES NO YES NO REPLACING THERMOSTAT YES NO YES NO NEW 4"CONCRETE SLAB Y S NO YES NO NEW ROOF STAND YES NO YES NO NEW RETURN PLENUM BOX YES NO 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit (208( 40 80): 4. Size Disconnecting Means: Contractor's Company Name: XA;I%GP A1006< �/ZaJel Phon4 �a— J ��6_'' State Certificate or Registration No. Q Certificate of Competency No. Signature Date: (Qualifier's signature) (Revised02/24/2014) This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between Feb 17, 2009 and Dec 31, 2016. AHRI Certified Reference Number: 7943535 Date: 2/29/2016 Product: Split System: Air -Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: RA1648AJ1 Indoor Unit Model Number: RH1T4821STAN Manufacturer: RHEEM SALES COMPANY, INC. Trade/Brand name: RHEEM; RUUD Region: All (AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, Hl, ID, IL, IA, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WV, WI, WY, U.S. Territories) Region Note: Central air conditioners manufactured prior to January 1, 2015, are eligible to be installed in all regions until June 30, 2016. Beginning July 1, 2016, central air conditioners can only be installed in region(s) for which they meet the regional efficiency requirement. Series name:, —,- Manufacturer responsible for the rating of this system combination is RHEEM SALES COMPANY, INC. Rated as follows in accordance with AHRIStandard210/240-2008 for Unitary Air -Conditioning and Air -Source Heat Pump Equipment and subject to verification of rating accuracy by AHRI-sponsored~ independent, third parry testing: _ I— - . _ I I I i Cooling Capacity (Btuh): 45000 EER Rating (Cooling): 13.00 SEER Rating (Cooling): 16.00' IEER Rating (Cooling): Ratings followed by an asterisk (") indicate a voluntary rerate of previously published data, unless accompanied with a WAS, which indicates an involuntary rerate. DISCLAIMER AHRI does not endorse the product(s) listed on this Certificate and makes no representations, warranties or guarantees as to, and assumes no responsibility for, the product(s) listed on this Certificate. AHRI expressly disclaims all liability for damages of any kind arising out of the use or performance of the product(s), or the unauthorized alteration of data listed on this Certificate. Certified ratings are valid only for models and configurations listed in the directory at www.ahridIrectory.org. TERMS AND CONDITIONS This Certificate and Its contents are proprietary products of AHRI. This Certificate shall only be used for Individual, personal and confidential reference purposes. The contents of this Certificate may not, in whole or in part, be reproduced; copied; disseminated; entered Into a computer database; or otherwise utilized, in any form or manner or by any means, except for the user's individual, personal and confldential reference. AIR-CONDITIONING. HEATING, CERTIFICATE VERIFICATION & REFRIGERATION INSTITUTE The information for the model cited on this certiflcate can be verified at www.ahridirectory.org, click on "Verify Certificate" link we make life better - and enter the AHRI Certified Reference Number and the date on which the certificate was Issued, which Is listed above, and the Certificate No., which Is listed at bottom right. ©2014 Air -Conditioning, Heating, and Refrigeration Institute This combination qualifies for a Federal Energy', Efficiency Tax Credit when placed in service'. between Feb 17, 2009 and Dec 31, 2016.', Certificate of Product Ratings AHRI Certified Reference Number: 7943535 Date: 2/29/2016 Product: Split System: Air -Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: RA1648AJ1 Indoor Unit Model Number: RH1T4821STAN Manufacturer: RHEEM SALES COMPANY, INC. Trade/Brand name: RHEEM; RUUD Region: All (AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, ID, IL, IA, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WV, WI, WY, U.S. Territories) Region Note: Central air conditioners manufactured prior to January 1, 2015, are eligible to be installed in all regions until June 30, 2016. Beginning July 1, 2016, central air conditioners can only be installed in region(s) for which they meet the regional efficiency requirement. Series name:- _ __. , _1\ Manufacturer responsible for the rating of this system combination is RHEEM SALES COMPANY, INC. Rated as follows in accordance with AHRI Standard 210/240-2008 for Unitary Air -Conditioning and Air -Source Heat Pump Equipment and subject to verification of rating accuracy by AHRI-sponsored, independent, third party testing: I Cooling Capacity (Btuh): 45000 EER Rating (Cooling): 13.00 SEER Rating (Cooling): 16.00 - — — - - IEER Rating (Cooling): " Ratings followed by an asterisk (') indicate a voluntary rerate of previously published data, unless accompanied with a WAS, which indicates an involuntary rerate DISCLAIMER AHRI does not endorse the product(s) listed on this Certificate and makes no representations, warranties or guarantees as to, and assumes no responsibility for, the product(s) listed on this Certificate. AHRI expressly disclaims all liability for damages of any kind arising out of the use or performance of the product(s), or the unauthorized alteration of data listed on this Certificate. Certified ratings are valid only for models and configurations listed In the directory at www.ahridirectory.org. TERMS AND CONDITIONS This Certificate and Its contents are proprietary products of AHRI. This Certificate shall only be used for Individual, personal and confidential reference purposes. The contents of this Certificate may not, in whole or In part, be reproduced; copied; disseminated; , entered Into a computer database; or otherwise utilized, in any form or manner or by any means, except for the user's individual, personal and confidential reference. AIR-CONDITIONING. HEATING, CERTIFICATE VERIFICATION & REFRIGERATION INSTITUTE The information for the model cited on this certificate can be verified at www.ahridltectory.org, click on "Verify Certificate" link wc„,ake life better - and enter the AHRI Certified Reference Number and the date on which the certificate was issued, which Is listed above, and the Certificate No., which is listed at bottom right. ©2014 Air -Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 1310124643104922 RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE..OF'F`L•ORIDA `SSIONAL REG. DEPARTMENT OF BUSINESS. AND PROFE�1LATlON CONS'rItUCTION INDUSTRY L_ICENSIN.G BOARD.` �MC`I249885HE — The MECHANICAI.�CONTRAOTQR ,1'•�'�t'yo-k�`',,"',��ak.,,5 � :. �i�, � ` ,�* . I'.. Named tedoW IS.:CERTIFIED Gndor the.pr©vlsions,.of'Clapter 489FS 1 Explraho'h d�te� p .1 2p.16 "'r�;`� � hw f^y ' , ^i.J _I�egn l `,4 \ \'11 ``.;'1`n.• ..t`•, �\\�'--+".6,3�°'.I• • ►f I p Eb111 �. C r /�.t_•�....p , SrnNj,ti�w11 4 1- '���.� Mti � � _ \�,•_ �'� ••,,� ' : •. , •�,,. i,\ .�ry� I � � �/y' � M.� '. ••CGRNrJN�4i- l.GI�I'ILQ� r''.1Nart4 ` '� 9'''r••�t_'„ :\ �.^\,` I 1„y� "••,'`\ ''"'t'".,•� `��"� ''�`` y,\."��, I�Y'iw" r{�'�w4'� '� KARI5E MSCHANI.C'A� �, C�•,� 7G 1827.5_S�ly°936TM; T G� ?f.l eta �w.nuj w ti� I h� ti !�" ' %r! �,..'f �"M,IAfyll-....�.�•,^. ^-..`f�"�-i7Jr`I�6 ,y •'�i'` �,- ?"1w1.'' "F n kF�,' 1 I 4' ♦ '` I 17. 'r � r��'' � �� , 1 N ry : �, �w 4 � 'W' "7+{.4 ti lr i µa �'`f _ � J4 1 f w i .. � 1 `�•„� \ � � � at `•F�( 11N., .�"..''J'. '��• ✓ r"'� .^..v � �y,::'1,� � .� :.._ Ry`.Yr....._]. �.�.... a.IP��..'�i�n,�.I�.A[I..{�:.'a7i.1'`�.._�..L��_'nl._\�1....>.��1._?�...i..1-!_J...�:��•. .-._ .i _ ISSUED: 061*1512014 DISPLAY AS REQUIRED BY LAW SEQ # L1406150001597 Local Business Tax Receipt Miarni--Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 6829502 BUSINESS NAME/LOCATION RECEIPT NO. KARIBE MECHANICAL SERVICE RENEWAL LLC 7103179 13275 SW 136 ST 22 MIAMI, FL 33186 L Hmmmh'T. EXPIRES SEPTEMBER 30, 2016 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS PAYMENT RECEIVED KARIBE MECHANICAL SERVICE t_LC 196 GENERAL MECHANICAL BY TAX COLLECTOR CARLOS A FERNANDEZ, QUALIFIER CONTRACTOR 75.00 07/09/2015 Worker(s) 2 CMC1249885 CHECK21-15-083919 This Local Business Tax Receipt only confirms payment of tho Local Business Tax, The Receipt Is nor a license, Permit, or a cortificalion of the holder's qualifications, to do business. Holder must complywith any governmental or nongovernmental regulatory laws and requirements which apply to Ilse business. The RECEIPT N0, above must be displayed an all commercial vehicles— Mianll—Oado Code Sec On-276. MIAM4nA0E 0Efor more information, visit wvnwZiLglgidl7�r,gQvjte xC011Ccter tz'r,^1 A cclomb CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must he endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In Ileu of such endorsement(s). PRODUCER HAw; Pablo M Conde A8A Underwriters Inc. PHONE (305)_22D-7447 N, ; (305) 220-4821 8778 SW Bar U'DREss: Pm�aaunderwrlters.com ' AODRE INSURER "ICOVERAGE NAM P wNRa:R A: BRIDGEFIELD EMPLOYERS INSURANCE CO. wSURER a: Miami_ FL 33174 IN9LeUl1 wsumtr.: KARIBE MECHANICAL SERVICE LLC INSURER D: 16300 SW 137 Avenue, Bay 122 INSURER E: INSURER I Miami FL 33177 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE POLICY NUMBER FF SIS % LMITS COMMERCIAL GENERAL DA11— CIIS.6fAA0E OCCUR EACH OCCURRENCE S ETO1MWTE1Y-- f SEDFXP mepenm) f PE4anHLL a AOV NU v GENERAL AGGREGATE f GENL AOISREGATE UIIT APPlIE4 PER PG,,cY �LOC OTHER: f TCOUCTS- CGMPIOP AGO S $ AUTOMOBLE L—LRY ANYAUTO NED ALL AUTOSS AUODULED Np1�.NED MREDAUTOS AUTOS COIAeINED SINGLE LIMB S eOOILYINJURY(P.P—) $ BOOILY INJURY (Par W&lk f PERTY DPJ.IA E $ f UMBRELLA LAB EXCESS LAB OCCUR CLAIMS-MAOE EACH OCCURRENCE f AGGREGATE f DED RETENTIONS $ A WORMERS COMPb"OON AND EMPLOYERS' UABRJIY YIN INYPR°MAEMBE P CLUDEE%ECUTNE OFPIOERAEMeea EXCLUOEm �N (MAnd�lary In NN) Eyyssee drulb MldPr DF.SGRenION OF OPEIATIOH,S bVo+ NIA 830-47539 03/03/2016 03103/2017 �/ X STATUTE IER E.L. EACH ACCIDENT S 1.000,ODO EL. DISEASE -FA EMPLOYE f 1,000,000 E.1- D"FASE-POIIOY LIMIT f 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 1H, Add .I R—kE S.—Ie, may b FU.,Md II. .. h rp —) New Unit and New Refrigerant Lines SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village Building Dept. ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Avenue AUTHORIZED REPRESENTATIVE Miami Shores, FL 33138 1z L---- m 1988-2014 ACORD CORPORATION. All riuhta rw .—d_ ACORD 25 (2014/07) The ACORD name and logo are registered marks of ACORD AI—, CERTIFICATE OF LIABILITY INSURANCE D ATE 5/0611IYYY"' osle6ns THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the ca"ificst, holder I. an ADDITIONAL INSURED, the polky(les) must be endorsed. If SUBROGATION IS WANED, subject to the I— and conditions of the policy, certain PoNclas may mqulm en and orsama.L Aslalemant on this certificate time not confer rights to the certificate holder In Ilan of such endersementis). PRODUCER MEACT Me1kN Wong Franklin Insuralx;e Group 305 -3923 ICNa,EM1:�_ -(n c, Nol:. i765964 71908W 671h Avenue, Suite 407 a9EBs. frenklingroup®beesoulh.net Mlaml, FL 33173 INSIME S AFFORDING COVERAGE NAICA Phone 305)630-3923 Fax (306)675-59U WsuRERA: W"n WDAd Insurance Conpeny AM BEST A Ecanen INSURER B: soil O si 1 R c : Karibe Medranical Service, U-C 16300 SW 137 Avenue, Bay 122 INSURER D: INSURER E : Mland FL 33177 INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THI9 IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR ANY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRI8ED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. UNITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IMSR TYPE OF INSURANCE POLICY EFF POLICY EXP LTA POLICYNUMBER DOZY , MAVEe LJMRS GENERAL LIABILITY-EACHEArCC" 009.9D Q COMMERCIAL GENERAL OABIITY WLIGETU ReIIiED E I,. Boom ❑ ❑ clnRas-MnDE DCC- NPPa3i9119 APED ExP yvlFan. parson S 5.008.00 A 1/ PDIBI DED 250 N 34/1912016 04/19/2017 ❑ PEi4^rWAL SAOV WJWY E 1,000,000.00 ❑ _ _ GENERAL ADCREGITE s 2 000,000.00 GENL AGGREGATE LWIT APPLIES PER: PRODUCTS -COMP—AGG S 2. D00.000.00 ❑ POLICY ❑ LOC $ AUTOMOBILE LABXITY COM&IIED BANGLE LIMIT Ea c N ❑ ANYAUTO BODILY INjustyoer panan) s I1 atrms ❑ 5 0D1lEO L❑J BOOILYINJURYIPerec dml; $ HPED AVTO$ ❑ OWNED El RtOPEAcTY E s s ❑ UMBRELLAUAB ❑OCCUR EACH OCCURRENCE ItEXCESS LAB ❑ CLAIMS -MADE AGfJRGgTE E DED ENTIONs $ ... WORKERS COMPENSATION YIC STATU OT4 AND EMPLOYERS' LABILITY YIN E.L. FArH ACCDENi S AN V PROPRIETIXLPARTNEPJE%EGUTNE OFFICEFJMEMBER EXCLUDED? $ ❑N[A au dal -In NIB El. DISEASE -EA EMPLOYE fyyee desa4e OF OPERATIONS O DESI:RIPTM]N OF bioN I E.L. DISEASE - POLICY Igst s DESCRIPTIONOFOPERATIONSI LOCATION31V 11CLE$ fAtlecb ACOR01a1, Mdllknel Remarks Schetlule, Il mon apxabrequirM) New Unit and New ReOigeration Lines CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village Building Dept THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE. 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE MAIKEL W ONG 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) OF TM ACORDname and logo are registerod marks of ACORD